Neurogenic thoracic outlet syndrome

The thoracic outlet region is comprised of three anatomic spaces: the scalene triangle; the costoclavicular space; and the pectoralis minor space. The neurovascular bundle, which consists of the subclavian artery (SCA), subclavian vein (SCV), and brachial plexus, courses through the scalene triangle to the costoclavicular space and then through the pectoralis minor space. Compression of the neurovascular bundle components anywhere along this trajectory can result in similar symptomatology because the vessels and nerves do not change substantially within the thoracic outlet region. Neurogenic thoracic outlet syndrome (NTOS) results from brachial plexus compression, which leads to a constellation of neurologic symptoms of the upper extremity. Variations in anatomy of the thoracic outlet region, as well as injuries and repetitive physical activities, can predispose a patient to the development of NTOS.